Urine drug testing in an athlete leads to the diagnosis of unsuspected mediastinal germ cell tumor.
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Biomedical subjects
Publications and source records attributed to C Peter Clarke.
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OBJECTIVE: To identify the significance of spontaneous pneumomediastinum (SPM) and to optimize its management. METHODS: A retrospective analysis was undertaken of all patients presenting with SPM over a 5-year period. Eighteen patients were identified, and information on their presentations, initial diagnoses, comorbidities, investigations, clinical courses, length of hospital stays, and outcomes were collated. SETTING: The emergency department referrals of two major Melbourne teaching hospitals. RESULTS: SPM is an uncommon condition presenting in approximately 1 in 30,000 emergency department referrals. The typical patient identified from this study is a young man who is likely to have a history of asthma, and who is also likely to smoke or to use illicit drugs. The most common presentation is nonspecific pleuritic chest pain with dyspnea. Complications are rare, and the clinical course benign, but the possibility of a ruptured viscus or an initial misdiagnosis often leads to a great number of investigations. A proposed algorithm of management is given. Other serious and potentially life-threatening conditions, such as Boerhaave syndrome need to be excluded.
Hand-assisted thoracoscopic surgery is a novel minimally invasive approach for performing techniques conventionally performed by posterolateral thoracotomy. Hand-assisted thoracoscopic surgery overcomes one of the major drawbacks of minimally invasive thoracic surgery in allowing full manual palpation of the lungs through a subcostal incision under video guidance, while avoiding a thoracotomy when the indication is pulmonary metastasectomy with curative intent or resection of undiagnosed lung nodules. The technique may result in improved quality of life outcomes compared with a thoracotomy.
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We report a case of persistent twitching of the latissimus dorsi muscle following a posterolateral thoracotomy, which continued despite several attempts at control including denervation, and was ultimately cured by total resection of the muscle.